股动脉双路搭桥的血流动力学仿真

在传统股动脉搭桥术中，由于下游缝合区采用“端对侧”的“单路搭桥”缝合方式，移植管中血流会对缝合区底面产生很大冲击，引起局部血流动力学急剧变化，并可能因此而导致血管再狭窄和手术失败。由于缝合区几何结构的不对称必然导致流场的不均匀，本研究提出了“对称双路搭桥”的构想以图改善血流动力学。本研究对“单路”和“对称双路”两种连接模型中的血液流动进行了数值模拟。两种模型利用相同的几何参数进行建模，并采用了相同的边界条件。数值模拟结果包括流场、壁面切应力及其梯度等血流动力学参数。研究表明，“对称双路”模型比“单路”模型具有较大的纵向速度、较小的二次流、较均匀的壁面切应力等。因此，“对称双路”搭桥模型具有更好的血流动力学，可以减少股动脉搭桥术后内膜增生和再狭窄的可能性。     

一种可以避免血管再狭窄的双移植管搭桥方式的数值模拟

目的为改善冠状动脉旁路移植管的局部血流动力学,降低血管再狭窄的发生机率,研究一种可以避免血管再狭窄的双移植管搭桥方式。方法利用有限元分析方法,对传统模型和双移植管搭桥模型进行血流动力学模拟仿真,计算缝合区附近的流场、壁面切应力等血流动力学因素的分布情况。结果该双移植管搭桥具有较好的血流动力学分布,明显改善了主搭桥血管与冠状动脉缝合处的血流动力学参数,消除了该部位的涡流和流动停滞点,提高了底面的壁面切应力数值。在辅助搭桥血管与冠状动脉缝合处涡流区长度仅3 mm,与原主搭桥血管缝合处的涡流长度4.5 mm相比明显减小。辅助搭桥管分流了约36%的血液,只有约64%的血液流过了主搭桥管。结论该双移植管搭桥有助于减小内膜增生的发生机率。     

主动脉夹层及其移植管搭桥术的二维数值模拟

目的探讨搭桥术对主动脉夹层假腔内血流动力学参数的影响及该术式的治疗有效性。方法利用AutoCAD软件构建DeBakeyⅢ型主动脉夹层及其移植管搭桥术的理想化二维几何模型,然后利用ANSYS软件进行数值模拟,分析计算结果的血流动力学特性。结果在实施搭桥手术后,假腔内的血流速度与压力均小于实施搭桥手术前的值。结论利用旁路搭桥转流术可有效地降低主动脉弓的血压,减轻血流对夹层病变的冲击和压力。由此推之到其对防止夹层破裂,促进夹层局部病变愈合,是一种有效的手术方式。     

缝合式和机械吻合式搭桥模型的血流动力学数值模拟

为了说明机械吻合器的引入对冠状动脉搭桥术近端吻合区血流动力学因素的影响,运用Solidworks软件构造了缝合式和机械吻合式两种搭桥模型。运用有限单元数值模拟的方法和Fluent6.3软件,对两种模型移植血管中脉动流进行数值化模拟和可视化分析。获得了吻合区在一个心动周期内不同时刻的速度场、二次流、压力及壁面切应力的分布情况。结果表明,机械吻合器的引入在增大移植血管中血流速度（大于缝合模型约0.2 m/s）的同时使得低速区范围增大,吻合区壁面切应力变化范围为0～50 Pa,应力集中现象明显,壁面切应力变化剧烈,易引起血小板活化和内膜增生。为了提高冠状动脉搭桥术的通畅率,对机械吻合器进行优化设计很有必要。     

冠状动脉搭桥血流动力学数值模拟

目的深入研究缝合区附近的血流动力学特性,这对于了解内膜增生的发生机制以及提高冠状动脉搭桥畅通率有重要的指导与临床意义。方法通过运用三维重建软件和逆向工程软件从CT医学图像中重建出弯曲冠状动脉模型,并考虑移植管缝合到冠状动脉上时端口的变形。采用有限体积法数值研究的方法,模拟冠状动脉搭桥术中下游缝合区附近的血液流动的流场。结果临床上常出现内膜增生的位置都存在不正常的血流动力学现象,缝合前端和缝合后端都出现了严重的回流现象。结论在冠状动脉旁路移植术中,移值管远端应缝合到曲率较小的冠状动脉上。     

双路搭桥术的移植管直径对血液流动的影响

移植管直径对搭桥术的长期通畅率具有至关重要的作用.为了弄清楚移植管直径对双路搭桥术中血液流动的具体影响,利用数值仿真的方法对两个股动脉双路搭桥模型中的生理脉动流进行了研究.为便于比较,除移植管直径不同以外,两个模型均采用相同的几何参数来建模.我们将研究直径一小和一大两个模型.两个模型的流动仿真边界条件相同.峰值雷诺数为832.8,Wcmersley数为6.14.重点分析了下游缝合区流场.对速度场、上下游足尖的压力差、壁面切应力及其梯度、应力波动系数等血流动力学参数的时空分布进行了比较.研究表明,大直径移植管模型下游缝合区的纵向速度和二次流速度较为紊乱,而其足尖下游远端的轴向流动则具有较大而均匀的纵向速度.同时,大移植管模型具有较小的回流、较均匀的壁面切应力、较低的压力、较小的壁面切应力梯度等特点.然而在二次流分布和应力波动系数方面却没有优势.总之,大移植管模型在近壁部分具有更好、更均匀的血流动力学现象,可以有效地避免术后内膜增生和再狭窄的发生和发展.     

具不同狭窄-吻合口位置关系的冠状动脉搭桥术的血流动力学仿真分析

目的通过有限元仿真探索带有辅助搭桥血管模式的冠状动脉搭桥术中,辅助搭桥管吻合口与冠状动脉狭窄处之间的距离对该吻合口及其下游区域的血流动力学影响,为带有辅助搭桥管的新型冠状动脉搭桥术的临床应用提供理论指导。方法利用有限元分析方法,假定血液为不可压缩牛顿流体,建立3种搭桥血管模型,其冠状动脉上吻合口和狭窄的距离分别为0.0045 m、0.006 m和0.009 m。通过仿真结果考察不同模型中的血流速度、壁面切应力等参数的变化。结果吻合口与狭窄处之间的距离不同,冠状动脉血管内的血流动力学参数也不相同。速度方面,心动周期0.09 s时刻L1.5模型中吻合口足跟处轴向截面的最大速度约为0.54 m/s,同时刻L2和L3模型中其最大速度分别为0.45 m/s和0.37 m/s。壁面切应力方面,0.09 s时刻,L1.5模型中吻合口对应面的血管壁上其流动停滞点距离吻合口足跟仅为0.0024 m,同时刻L2和L3模型中其流动停滞点距离足跟处分别为0.0039 m和0.0068 m,长度明显增加。其他时刻流动停滞点分布有相同趋势。结论在实施冠状动脉搭桥术时,吻合口与狭窄处之间保持较大的距离,有利于改善吻合口处的血流动力学环境,降低吻合口处发生再狭窄的可能性。     

冠状动脉搭桥术中移植管-宿主动脉直径比和缝合角的优化与分析

目的探索怎样的移植管-宿主动脉直径比和缝合角可以最大限度地提高冠状动脉搭桥术的成功率。方法借助ANSYS9.0对冠状动脉搭桥术进行模拟仿真,用响应面方法建立数学模型,利用优化理论寻找最优的移植管-宿主动脉直径比和缝合角,使影响手术成功率的主要因素-壁面切应力梯度最小。结果结果表明冠状动脉搭桥术中,大移植管-宿主动脉直径比和小缝合角的模型具有更好的血流动力特性。结论影响冠状动脉搭桥术成功率的因素很多,在现有条件下借助临床经验指导,选择尽可能大的移植管-宿主动脉直径比和尽可能小的缝合角的做法是可取的。     

具有不同移植管-宿主动脉直径比的冠状动脉搭桥术的血流动力学仿真比较

为了说明移植管-宿主动脉直径比对冠状动脉搭桥术的流场及壁面切应力的影响，构造了三个具有不同移植管-宿主动脉直径比的冠状动脉搭桥术模型，三个模型的移植管直径分别小于、等于和大于宿主动脉的直径；利用有限单元数值模拟方法对三个模型中的生理性脉动血流进行了仿真分析；对流场、壁面切应力及其相关系数的时空分布进行了显示和比较。结果表明，大直径比的模型具有相对较大的纵向速度、大而均匀的壁面切应力以及小的壁面切应力梯度，从而在一定程度上改善了血流动力学；在搭桥术应用中采用大于或等于1的直径比是可取的。然而，在三个模型中，与壁面切应力相关的时间参数并没有显著差别。为了提高冠状动脉搭桥术的畅通率，设计新的缝合结构是很有必要的。     

端对端缝合股动脉搭桥术的流动分析

在一般"端对侧"股动脉搭桥术中,由于缝合区几何结构的突变必然导致流场的不均匀.移植管中血流会对缝合区底面产生很大冲击,并影响手术效果.为改善此种现象,作者提出了"端对端"连接方式,并对"端对侧"和"端对端"两种连接模型中的血液流动进行了数值模拟.为便于比较,两种模型利用相同的几何参数进行建模,采用相同的边界条件,数值模拟利用计算流体动力学中的有限单元法进行计算.结果展示了流场、壁面剪切应力及其梯度等血流动力学的时空分布情况.经比较表明,"端对端"模型比"端对侧"模型具有较大的纵向速度、较小的二次流、较均匀的壁面剪切应力等.因此,"端对端"模型具有更好的血流动力学,可以改善搭桥效果.     

Numerical simulations of stenosed femoral artery with symmetric 2-way bypass graft

The numerical simulation of the conventional 1-way bypass graft and the presented 2-way bypass graft used in the stenosed femoral arteries were completed. Purpose of the present study was to ascertain whether the modified geometry configuration of 2-way bypass graft could improve the flow conditions of femoral bypass graft. The physiological flows in 1-way and 2-way models were simulated with finite element method under the same calculation conditions. Comparisons were made between the hemodynamics of 1-way and 2-way models. The results suggested that 2-way bypass graft could result in more favorable and regular flow conditions than 1-way bypass graft, and could decrease the probability of intimal hyperplasia, restenosis and surgery failure in femoral bypass graft.     

Influences of graft diameter on the blood flow in 2-way bypassing surgery

The graft diameter plays a critically important role in the long-term patency rates of bypass surgery. To clarify the influence of graft diameter on the blood flows in the femoral 2-way bypass surgery, the physiologically pulsatile flows in two femoral bypass models were simulated with numerical methods. For the sake of comparison, the models were constructed with identical geometry parameters except the different diameters of grafts. Two models with small and large grafts were studied. The boundary conditions for the simulation of blood flow were constant for both models. The maximum Reynolds number was 832.8, and the Womersley number was 6.14. The emphases of results were on the analysis of flow fields in the vicinity of the distal anastomosis. The temporal-spatial distributions of velocity vectors, pressure drop between the proximal and distal toe, wall shear stresses, wall shear stress gradients and oscillating shear index were compared. The present study indicated that femoral artery bypassed with a large graft demonstrated disturbed axial flow and secondary flow at the distal anastomosis while the axial flow at its downstream of toe was featured with larger and more uniform longitudinal velocities. Meanwhile, the large model exhibits less refluences, relatively uniform wall shear stresses, lower pressure and smaller wall shear stress gradients, whereas it does not have any advantages in the distributions of secondary flow and the oscillating shear index. In general, the large model exhibits better and more uniform hemodynamic phenomena near the vessel wall and may be effective in preventing the initiation and development of postoperative intimal hyperplasia and restenosis.     

Computational Investigation of Hemodynamics in Fully Stenosed CABG

Coronary Artery Bypass Graft (CABG) is an important surgical treatment for critically stenosed arteries. Unfortunately restenosis always occurs after CABG surgery, which bring about surgery failure, lntimal thickening in the CABG distal anastomosis has been implicated as the major cause of restenosis and long-term graft failure. The nonuniform hemodynamics including disturbed flows, recirculation zones, oscillating wall shear stress, and long particle residence time were thought to be the possible etiologies. Numerical simulation was proved to be of great help and guidance meaning for the biofluid mechanics research and the CABG surgical plan. The present study was based on the hypothesis that the geometry configuration of CABG could greatly influence the hemodynamics in the vicinity of anastomosis. The hemodynamic features of two geometry models of end-to-side CABG were studied and compared. One simulated a conventional CABG with 1-way bypass graft, and the other simulated a modified CABG with symmetric 2-way bypass graft. The numerical investigations of hemodynamics in these two models with fully stenosed coronary arteries were accomplished using finite element method. The temporal and spatial distributions of hemodynamics were analyzed and compared. Results showed that the presence of symmetric 2-way bypass graft was of reasonable and favorable hemodynamics than 1-way bypass graft. The modified CABG model created a more hemodynamically efficient streamlined environment with higher mean and maximum axial velocities and lower radial velocities than the conventional 1-way model. Meanwhile, the symmetric 2-way bypass graft was featured with low pressure near the wall, high and uniform WSS in the host artery. All of these were favorable for inhibiting the development of intimal thickening, restenosis, and ultimate failure of the CABG, and it could considerably improve the flow conditions and decrease the probability of intimal hyperplasia and restenosis of CABG.     

Estimation of wall shear stress in bypass grafts with computational fluid dynamics method

Coronary artery bypass graft (CABG) operation for coronary artery disease with different types of grafts has a large clinical application world wide. Immediately after this operation patients are usually relieved of their chest pain and have improved cardiac function. However, after a while, these bypass grafts may fail due to for example, neointimal hyperplasia or thrombosis. One of the causes for this bypass graft failure is assumed to be the blood flow with low wall shear stress. The aim of this research is to estimate the wall shear stress in a graft and thus to locate areas were wall shear stress is low. This was done with the help of a blood flow computer model. Post-operative biplane angiograms of the graft were recorded, and from these the three-dimensional geometry of the graft was reconstructed and imported into the computational fluid dynamics (CFD) program FLUENT. The stationary diastolic flow through the grafts was calculated, and the wall shear stress distribution was estimated. This procedure was carried out for one native vessel and two different types of bypass grafts. One bypass graft was a saphenous vein and the other one was a varicose saphenous vein encased in a fine, flexible metal mesh. The mesh was attached to give the graft a defined diameter. The computational results show that each graft has distinct areas of low wall shear stress. The graft with the metal mesh has an area of low wall shear stress (< 1 Pa, stationary flow), which is four times smaller than the respective areas in the other graft and in the native vessel. This is thought to be caused by the smaller and more uniform diameter of the metal mesh-reinforced graft.     

2型糖尿病小鼠移植静脉再狭窄的血管平滑肌分布和功能的初步研究

目的 在构建2型糖尿病小鼠下腔静脉移植模型的基础上,观察糖尿病对移植术后桥静脉再狭窄后血管平滑肌的影响.方法 取20只8周龄雄性自发2型糖尿病C57 BL/KsJ leprdb/db(db/db)小鼠和20只C57 BL/KsJ野生型小鼠,建立下腔静脉-颈总动脉旁路移植手术动物模型,通过超声评估移植后血管血流及血管直径.应用苏木精-伊红(HE)染色及免疫组化染色观察静脉移植术后形态及平滑肌细胞标志蛋白表达水平,评估糖尿病对小鼠移植静脉再狭窄和血管平滑肌功能的影响.结果 超声结果显示,db/db小鼠移植静脉血管直径及血流速度均显著低于正常小鼠.形态学染色结果显示,与正常对照组比较,db/db小鼠静脉移植术后桥静脉血管壁厚度明显增加,α-SMA阳性的平滑肌细胞分布明显多于对照组,中膜平滑肌细胞占血管壁比例增加.结论 糖尿病是移植静脉再狭窄的不利因素,利用db/db小鼠进行静脉移植后,能够改善糖尿病小鼠冠状动脉搭桥术后移植静脉再狭窄的状况.为临床提供了实验依据.     

Influence of graft-host diameter ratio on the hemodynamics of CABG

The graft-host diameter ratios have impacts on the flow patterns of bypass graft. In order to clarify the influence of graft-host diameter ratios on the flow patterns and the wall shear stress in coronary artery bypass graft (CABG), the pulsatile blood flows in three CABG models, with the graft diameter larger than, equal to and smaller than that of the coronary artery, were simulated with finite element method. The temporal-spatial distributions of flow patterns, wall shear stresses (WSS), wall shear stress gradients (WSSG), oscillating shear index and shear stress ratio were depicted and compared. Of the three models evaluated, large model can bring about better hemodynamics to some extent with relatively large positive longitudinal velocity, uniform and large WSS, and small WSSG. The results suggest that larger or isodiametric graft is favorable. However, no distinct difference of WSS based temporal parameters was found between all the three models. Alternative anastomotic designs are necessary for the improvement of CABG patency rates.     

A comparative study of helical-type and traditional-type artery bypass grafts: numerical simulation

Preliminary studies on an individual helical graft indicated that its hemodynamics might be improved while pressure drop increased compared with a traditional graft. Aiming to investigate whether the benefits of a helical graft to hemodynamics dominate its deficits, this study numerically carried out comparative study of helical-type artery bypass graft (ABG) and traditional-type ABG under both steady and pulsatile flow conditions. The results showed that a helical-type ABG resulted in reduced oscillating shear index, improved wall shear stress, enhanced flow mixing and three-dimensionality, and improved flow behavior at the distal anastomosis and occluded section of the host vessel compared with traditional-type ABG. More important, although a helical-type ABG did increase the pressure drop compared with a traditional one, its maximum percentage increase during a cardiac cycle was <21% which is still within physiological sense. Therefore, we believe that the adoption of helical bypass could help to prevent intimal hyperplasia (IH) and thrombosis at the distal anastomosis and improve the graft patency while keeping clinical maintenance. This investigation provided an important basis for the clinical applications and theory support of helical graft.     

动脉血流旋动原理在人造血管研制和血管移植术中的应用

目的 将血液流动的旋动流原理用于心血管介入治疗,以期解决小口径人造血管的急性血栓堵塞问题和搭桥手术后下游处血管内膜增生引起的血管再狭窄问题。方法 使用计算流体力学（CFD）分别研究具有旋动流特性的新型小口径、S型搭桥和偏心搭桥模型中的流场以及壁面剪切力的分布。同时研究在旋动流下血小板的黏附情况和不同角度的S型搭桥下的血管内膜增生。结果 旋动流能明显提高壁面剪切力,抑制血小板的黏附以及血管内膜增生。结论 在心血管介入治疗和器械设计中引入旋动流确实可明显改善这些器械中的血流流场,达到抑制小口径人造血管的急性血栓形成和搭桥手术后血管内膜增生的目的。     

Anatomical bases of the bypass-flap: study of the thoracodorsal axis

Cutaneous tissue loss in patients with lesions on the arterial axes remains difficult to treat. Currently, combined surgery associating distal bypass and free flap seems to be the technique that yields the best results. The hemodynamic advantages of this technique, recently demonstrated, are the distal resistance and the increase in bypass flow. Nevertheless, it is complex and its indications limited. Two major drawbacks can be noted: The increasing risk of thrombosis due to the multiplication of anastomoses on the same arterial axis and the deterioration in venous autograft. To overcome these inconveniences we propose a new technique that we call bypass-flap (BF): the graft of an anatomical entity comprised of one artery and one flap. This graft secures the cover of tissue loss and the revascularization of the limb. Apart from its combined nature this technique presents three major advantages. The arterial autograft is superior to the venous graft, the gradually decreasing diameter of the artery secures the congruence of the anastaomoses, and the arterial flow of the graft is higher than a simple bypass due to the joint vascularization of the flap. The arterial graft includes the subscapular and the thoracodorsal arteries. The free flap is composed of serratus anterior muscle supplied by branches of the graft. This investigation studied the feasibility of the bypass flap and determined the length and diameter of the arterial graft and its muscular branch. Forty anatomical preparations were performed on 20 cadavers. The dissections were performed after injection of Rhodorsil. The anatomical feasibility of the bypass flap was confirmed in 37 cases. The total length of the arterial graft that preserved an external diameter above 2 mm was measured at 13 cm (8.5–15.5). This includes the subscapular artery and the thoracodorsal artery with its intramuscular part (if external diameter of that part always above 2 mm). The length of the pedicle of the serratus anterior flap was measured at 7.5 cm (3.0–12.5 cm).